NCLEX Questions for Renal Disorders 2025
A 22 y/o patient with diabetic nephropathy says, "I have two kidneys and I'm still young. If I stick to my insulin
schedule, I don't have to worry about kidney damage, right?" Which of the following statements is the best
response?
A. "You have little to worry about as long as your kidneys keep making urine."
B. "You should talk to your doctor because statistics show that you're being unrealistic."
C. "You would be correct if your diabetes could be managed with insulin."
D. "Even with insulin, kidney damage is still a concern." - ansD. "Even with insulin, kidney damage is still a
concern."
Rationale: Microvascular changes occur in both of the patient's kidneys as a complication of the diabetes.
Diabetic nephropathy is the leading cause of ESRD. The kidneys continue to produce urine until the end stage.
Nephropathy occurs even with insulin management.
A 30 y/o female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you
do to prevent complications associated with this device?
A. Insert IV lines above fistula
B. Avoid taking BPs in the arm with the fistula
C. Palpate pulses above the fistula
D. Report a bruit or thrill over the fistula to the doctor - ansB. Avoid taking BPs in the arm with the fistula
Rationale: Because the compression could damage the fistula. IV lines shouldn't be inserted in the arm used for
hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill should be reported to the doctor.
A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the
volume is 120 mL. The drainage system has no obstructions. Which intervention has priority?
A. Give a 500 mL bolus of isotonic saline
B. Evaluate the patient's circulation and VS
C. Flush the urinary catheter with sterile water or saline
D. Place the patient in the shock position, and notify the surgeon - ansB. Evaluate the patient's circulation and
VS
Rationale: A total UO of 120 mL is too low. Assess the patient's circulation and hemodynamic stability for signs
, of hypovolemia. A fluid bolus may be required, but only after further nursing assessment and a doctor's order.
A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure.
Which substance must be reduced in this patient's diet?
A. Carbohydrates
B. Fats
C. Protein
D. Vitamin C - ansC. Protein
Rationale: Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so
this patient's protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is
needed to ensure the growth and maintenance of the patient's tissues.
A patient with DM and renal failure begins hemodialysis. Which diet is best on days between dialysis
treatments?
A. Low-protein diet with unlimited amounts of water
B. Low-protein diet with a prescribed amount of water
C. No protein in the diet and use of a salt substitute
D. No restrictions - ansB. Low-protein diet with a prescribed amount of water
Rationale: Patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used w/o a
Dr's order b/c it may contain potassium, which could make the patient hyperkalemic. Fluid and protein
restrictions are needed.
A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you
include in his plan of care?
A. Apply pressure to the needle site upon discontinuing hemodialysis
B. Keep HOB elevated 45 degrees
C. Place the left arm on an arm board for at least 30 min
D. Keep the left arm dry - ansA. Apply pressure to the needle site upon discontinuing hemodialysis
Rationale: Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until
all the bleeding has stopped. Bleeding may continue for 10 min in some patients.
A 22 y/o patient with diabetic nephropathy says, "I have two kidneys and I'm still young. If I stick to my insulin
schedule, I don't have to worry about kidney damage, right?" Which of the following statements is the best
response?
A. "You have little to worry about as long as your kidneys keep making urine."
B. "You should talk to your doctor because statistics show that you're being unrealistic."
C. "You would be correct if your diabetes could be managed with insulin."
D. "Even with insulin, kidney damage is still a concern." - ansD. "Even with insulin, kidney damage is still a
concern."
Rationale: Microvascular changes occur in both of the patient's kidneys as a complication of the diabetes.
Diabetic nephropathy is the leading cause of ESRD. The kidneys continue to produce urine until the end stage.
Nephropathy occurs even with insulin management.
A 30 y/o female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you
do to prevent complications associated with this device?
A. Insert IV lines above fistula
B. Avoid taking BPs in the arm with the fistula
C. Palpate pulses above the fistula
D. Report a bruit or thrill over the fistula to the doctor - ansB. Avoid taking BPs in the arm with the fistula
Rationale: Because the compression could damage the fistula. IV lines shouldn't be inserted in the arm used for
hemodialysis. Palpate pulses below the fistula. Lack of bruit or thrill should be reported to the doctor.
A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the
volume is 120 mL. The drainage system has no obstructions. Which intervention has priority?
A. Give a 500 mL bolus of isotonic saline
B. Evaluate the patient's circulation and VS
C. Flush the urinary catheter with sterile water or saline
D. Place the patient in the shock position, and notify the surgeon - ansB. Evaluate the patient's circulation and
VS
Rationale: A total UO of 120 mL is too low. Assess the patient's circulation and hemodynamic stability for signs
, of hypovolemia. A fluid bolus may be required, but only after further nursing assessment and a doctor's order.
A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure.
Which substance must be reduced in this patient's diet?
A. Carbohydrates
B. Fats
C. Protein
D. Vitamin C - ansC. Protein
Rationale: Because of damage to the nephrons, the kidney can't excrete all the metabolic wastes of protein, so
this patient's protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is
needed to ensure the growth and maintenance of the patient's tissues.
A patient with DM and renal failure begins hemodialysis. Which diet is best on days between dialysis
treatments?
A. Low-protein diet with unlimited amounts of water
B. Low-protein diet with a prescribed amount of water
C. No protein in the diet and use of a salt substitute
D. No restrictions - ansB. Low-protein diet with a prescribed amount of water
Rationale: Patient requires some protein to meet metabolic needs. Salt substitutes shouldn't be used w/o a
Dr's order b/c it may contain potassium, which could make the patient hyperkalemic. Fluid and protein
restrictions are needed.
A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you
include in his plan of care?
A. Apply pressure to the needle site upon discontinuing hemodialysis
B. Keep HOB elevated 45 degrees
C. Place the left arm on an arm board for at least 30 min
D. Keep the left arm dry - ansA. Apply pressure to the needle site upon discontinuing hemodialysis
Rationale: Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until
all the bleeding has stopped. Bleeding may continue for 10 min in some patients.
